clay-shoveler fracture

Clay-shoveler fractures are fractures of the spinous process of a lower cervical vertebra.

Clinical presentation

Often these injuries are unrecognised at the time and only found incidentally years later when the cervical spine is imaged for other reasons.

Acutely they tend to be associated with :

  • motor vehicle accidents
  • sudden muscle contraction
  • direct blows to the spine

Radiographic features

The fracture is seen on lateral radiographs as an oblique lucency through the spinous process, usually of C7. There is usually significant displacement.

History and etymology

Originally described in Australia, among (no prizes for guessing) clay shovelers. Why clay rather than dirt or sand? The reason is due to the stickiness of clay. As clay shovelers lift the shovel upwards to toss the clay from deep ditches, the clay tends to stick to the shovel. This results in sudden forces on the neck and back muscles leading to the avulsion fracture.

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